Study Summary

Ninety-six patients with multilevel lumbar central spinal stenosis (LCSS) and lateral recess stenosis (LRS) were randomized to receive either total laminectomy with posterior spinal fusion (LF) (n=48) or microscopic bilateral laminotomy (n=48). However, only 76 patients completed the study. The primary outcome of interest was leg pain relief as measured by the visual analog scale (VAS). Secondary outcomes included revision surgery rates, complication rates, hospital stay duration, and intraoperative blood loss. Outcomes were assessed at 6–9 months and 18–24 months postoperatively. Overall, microscopic bilateral laminotomy was superior in pain relief (ΔVAS: 5.368 vs. 4.368, p = 0.001), had lower revision surgery rates (13.16% vs. 44.74%, p = 0.0047), and resulted in shorter hospital stays (p < 0.0001). However, it was associated with a higher rate of incidental durotomy (31.58% vs. 7.89%, p = 0.0190). These findings suggest that microscopic bilateral laminotomy may be a preferable surgical approach for patients with multilevel LCSS and LRS, though it carries a higher risk of durotomy.